AAEM/RSA FIX Scholarship Winners - Women in EM: Essay Two

Kimberly M. Brown, MD

Author: Kimberly M. Brown, MD
University of Tennessee Health Science Center (Memphis)

RSA is proud to share the following essay from one of the 2017 FemInEM Idea Exchange (FIX) Scholarship winners, Kimberly Brown, MD. Congratulations, Dr. Brown! 

Author Bio: Kimberly M. Brown, MD is a senior emergency medicine resident at the University of Tennessee Health Science Center in Memphis, TN. She was born and raised in Milwaukee, WI, then left the Midwest to complete her BA in Biology from Fisk University in Nashville, TN. Loving the warm weather, she moved to Gainesville, FL and completed a Master in Public Health from the University of Florida. She completed her medical education at Ross University School of Medicine. After completing residency, she will start a fellowship in neurocritical care at the University of Tennessee.

“YOU’RE Doctor Brown?” my elderly patient incredulously asks. I turn my badge around to squint at it and then look at my embroidered scrubs to double check. “That’s what it says on here!” My patient and her family members laugh. My patient touches my hand and tells me, “I am so proud of you.” Being black and female, I'm no stranger to a surprised reaction to my initial introduction. However, this time was different.

Combat and Cruise Ships: Reviving the Practice of Fresh Whole Blood Transfusion in Remote Environments

This post was peer reviewed.
Click to learn more.

Image Credit: Pixabay

Author: Scott Bland, MSIV
Campbell University School of Osteopathic Medicine

Whole blood was the only available transfusion product prior to the development of Cohn’s plasma fractionation process in 1947.[1] However, with advances in laboratory technology and more targeted therapies in hospital settings, the medical community has greatly increased the use of individual blood components, including red blood cells, platelets, and plasma. These components allow for more specific treatment effects, fewer unintended effects, potentially longer shelf life, and more uses per donation than whole blood.[2] In optimal situations, the contemporary choice of processed and screened donations is clearly the safest, but there are uses for fresh whole blood that merit consideration.

AAEM/RSA FIX Scholarship Winners - Women in EM: Essay One

Trisha Morshed, MD

Author: Trisha Morshed, MD
UCSD Department of Emergency Medicine

RSA is proud to share the following essay from one of the 2017 FemInEM Idea Exchange (FIX) Scholarship winners, Trisha Morshed, MD. Congratulations, Dr. Morshed!

Author bio: Trisha Morshed is an Emergency Medicine Resident at UC San Diego. She is originally from Portland, Oregon and went to undergraduate and medical school in Arizona. Her professional interests include a passion to make a difference both locally and globally. She is the Resident representative on the Board of Delegates of the San Diego County Medical Society, a physician group that meets regularly with local legislators for medical advocacy. She is also excited about global health and has been involved in international collaborative research as well as overseas projects to improve access to healthcare in resource limited settings. Trisha is a strong advocate for work/life balance and physician wellness-- on her downtime, she can be found traveling, playing outdoors, and practicing partner acrobatics.

When I was growing up, I was always told by my parents that with hard-work and perseverance, I could make my dreams a reality. I realized my passion for emergency medicine during third year of medical school during a shadowing experience, and feel so fortunate to find a field where I look forward to going to work most days and can’t imagine myself doing anything else. I have never felt that my gender hindered me at any point previously in my life; however, was surprised when I entered my residency at a place which is predominantly male, at how much I noticed the difference between how I was perceived differently from my male colleagues.

Acute Management in Pediatric Congestive Heart Failure

Image Credit: Wikimedia

This post was peer reviewed.
Click to learn more.

Author: Alfred Morrobel, M.D
Universidad Iberoamericana

Epidemiology
Congestive heart failure (CHF) in children is diverse due to the myriad underlying etiologies that can occur from birth to adolescence. In the United States, CHF is estimated to affect 12,000 to 35,000 children below the age of 19 years and there are approximately 11,000 to 15,000 heart failure-related hospitalizations in children per year.[1]

Board Review: Making Decisions Based on the EKG

This post was peer reviewed.
Click to learn more.

 

Image Credit: US Air Force

Author: Nick Pettit, DO PhD, PGY-2
Indiana University
AAEM/RSA Social Media Committee

Case
The setting is a busy shift in your high-acuity pod of your emergency department. You just walked out of room 1 after resuscitating a tricyclic antidepressant (TCA) overdose. Then overhead you hear, “trauma 1 here, room 4,” and at the same time your nurse hands you the below electrocardiogram (EKG).

As you are walking toward room 4 and scribble “non-ST-elevation myocardial infarction (non-STEMI),” she gives a quick history about this patient. The patient is a 77-year-old male with a past medical history of some kidney and heart issues, and he now has fatigue, shortness of breath, and bilateral lower extremity edema. Just as you pop into the trauma in room 4, you tell your nurse you will be right over, but to please draw a rainbow of labs and:

1. Administer 40 mL/kg 0.9% NaCl bolus.
2. Administer 3 g calcium gluconate.
3. Administer 6 vials of digi-bind.
4. Administer 40 mEQ of potassium chloride
5. Place pads and pull up ketamine for procedural sedation and immediate cardioversion.
6. Call poison control.

Correct answer
B. Administer 3 g calcium gluconate. This patient has hyperkalemia, and based on the EKG, it should not be surprising if their potassium returns at greater than 9.0.

This review will focus on the causes of hyperkalemia, its identification, and its immediate treatment.

Causes

1. Decreased excretion, such as in renal failure (as in this case)
2. Excessive potassium intake
3. Increased production of potassium (rhabdomyolysis, tumor lysis, trauma)
4. Redistribution (digoxin, acidosis)[1]

Identification

1. Basic metabolic panel (BMP). Be sure to watch for hemolysis, which can cause pseudohyperkalemia.
2. EKG. Different levels of potassium elevation can cause unique EKG findings:[2]
• ~6.0 = peaked T waves
• ~7.0 = P-wave evolution
• ~8.0 = wide QRS
• ~9.0 = sinusoidal appearance

Symptoms
Weakness, confusion, chest pain, nausea and vomiting, palpitations

Management

1. Calcium
• Calcium chloride if there is a central venous catheter (CVC), or calcium gluconate if there is peripheral access only.
• Stabilizes membrane in approximately ten minutes, with EKG returning to normal over several minutes.
2. Insulin and glucose
• Ten units of insulin given with dextrose.
• Works over 30 minutes
3. Sodium bicarbonate
• Helps correct acidosis
4. Albuterol
• Shown to lower potassium 1 mmol/L in healthy subjects
5. Dialysis
• May need emergent dialysis. Remember the AEIOU mnemonic:
• Acidosis
• Electrolyte disturbances
• Ingestion
• Overload (fluid)
• Uremia
• In the above case, the patient may benefit from emergent dialysis.
6. Furosemide
• May help if the patient is volume-overloaded, but this is a common disease in end stage renal patients and furosemide may have limited value here.[3]

References:

1. Rodriguez, J., Calvert J. Hyperkalemia. Am Fam Physician. 2006 73(2):283-290

2. Hall, B., Salazar, M., Larison, D. The sequening of medication administration in the management of hyperkalemia. J of Em Nurs. 2009 35:4;339-342

3. Wrenn, K., Slovis, C., Slovis B. The ability of physicians to predict hyperkalemia from the ECG. Annals of Emerg Med. 1992 20:11;1229-1232